Munchausen by Internet: The Lying Disease that Preys on the Heart

tnbutterfly - Mary, BSN

For decades, people have heard of Munchausen syndrome, a disorder characterized by people taking extraordinary measures to fake illnesses or psychological trauma for the sole purpose of attracting attention and sympathy from others. Munchausen sufferers will do almost anything to validate the delusion of their illness. Another variation of this disorder is Munchausen by proxy, in which people physically or psychologically harm loved ones to gain attention and sympathy. In more recent years, a newer variation of this disorder has been noted to infect online communities.

Munchausen by Internet

Internet traffic has exploded over the past two decades, providing users with instant access to information and networking with others. With the increasing number of online users and formation of online social communities and support groups, beginning in the 1990's there have been increasing reports of users who have deceived internet forum participants by portraying themselves as gravely ill or as victims of violence or psychological trauma. The internet was made for such fakers. Arming themselves with medical knowledge obtained through hours of perusing the internet, these users create intricate online stories of prolonged suffering and even death which end up being nothing more than fabrications.

A pattern for this new Munchausen variation was identified in 1998 by Dr. Marc Feldman, a clinical professor of psychiatry at the University of Alabama, and an expert on Munchausen syndrome and factitious disorder. Dr. Feldman coined the term "Munchausen by Internet" in an article published in 2000, "Munchausen by Internet: Detecting Factitious Illness and Crisis on the Internet".

What is Munchausen by Internet?

This disorder is essentially the same as the better known Munchausen syndrome, with the main difference being that people carry out their deceptions online. "On the Internet," Feldman explains, "it's very easy to fake. All you have to do is click and you go to another disease site. You can become an expert on anything in 30 minutes by visiting Google." At first, Munchausen by Internet was most common in online medical support groups, but variations of it now show up anywhere that people socialize online, such as social networking sites, blogs, forums, discussion groups and chat rooms. The fictitious stories can take months and even years to play out.

These deceivers are usually not newcomers to the site, but instead have already begun to weave their story of deception, making online friends while they are setting the stage. They portray themselves as incredible, wonderful and charismatic people. The drama unfolds in different ways but usually involves a sudden revelation by the writer that they have contracted a serious illness.

They may have already disclosed lesser challenges they have previously faced, just to ensure they have sympathetic listeners. All the time while weaving their web of deception, they are bravely coping with whatever tragic situation or string of situations they are facing. They go on to provide details of their declining situation, including hospitalizations, doctor appointments, treatments, etc.

Many times their condition/hospitalization will preclude them from using a computer, thus making it possible for another fictitious character to enter the picture and post in their place. This is usually a close friend or family member(s). They refrain from divulging their location or contact information such as telephone number. Most of these liars end up having shocking, sudden, or especially poignant deaths which is relayed by someone close to them. There may be a miraculous recovery, followed by relapses and more drama..... and prolonged suffering for both them and their followers. It will go on and on...

Red Flags

Put yourself in the place of one of the targeted "victims." At first, you are greatly saddened by the predicament of which the member posts. You want to help. You may even offer support. You find yourself drawn into the drama as it continues to unfold with layer upon layer of catastrophic detail. Slowly, you notice the story contains more and more discrepancies. You tend to make excuses for these inconsistencies, thinking the faker's thought processes may be clouded by the medications and illness. As the lies continue to pile up, you slowly come to the realization that you've "been had". And on that day, you feel like a total doofus. There is an overwhelming sense of betrayal as you realize you have been lied to, used, and manipulated. You may even feel angry at the perpetrator.

7 Clues To Detecting Munchausen by Internet Sufferers

Once you have been fooled by one of these liars, looking back you will see more and more inconsistencies and red flags in their story. While the stories vary greatly, the behavior of these people is consistent enough that Dr Feldman has described seven "clues to detection of false claims" based on numerous case studies.

The posts consistently duplicate material in other posts, in books, or on health-related websites;
The characteristics of the supposed illness emerge as caricatures based on the individual's misconceptions;
Near-fatal bouts of illness alternate with miraculous recoveries;
Claims are fantastic, contradicted by subsequent posts, or flatly disproved (e.g. a call to the hospital reveals that there is no such patient);
There are continual dramatic events in the person's life, especially when other group members have become the focus of attention;
The individual resists telephone contact or contact via mail, sometimes offering odd justifications
There is feigned blitheness about crises (e.g., going into septic shock) that will predictably attract immediate attention;
Others apparently posting on behalf of the individual (e.g., family members, friends) have identical patterns of writing.

Motivation

What motivates people to do this? Dr. Feldman states that the clue to their motivation "may lie in the power granted by online communities to quantify the sympathy for an illness or the shock of a death via comment boxes or replies to a journal thread." These fakers can sit back and read the comments of support from numerous readers who are following the created saga as their illness progresses. They relish the thought that their words are eliciting sadness and tears. "It feeds the desire of the narcissist and provides the lonely with the attention that they may never previously have known."

We know that this type of behavior will only increase as others take their lies to the internet. So what can we do? How do we respond? These people are seeking attention, so indifference is one of our defense tactics. As nurses on a nursing website or in any real-life situations we should of course be compassionate and supportive of others in genuine need. Most people online and in real life, are usually telling something close to the truth most of the time. They may embellish their story a bit, but nothing close to what we are referring to here.

Nurses Targeted

As an online nursing community, we are susceptible to being used by Munchausen by Internet sufferers, as well as deceptive posters in general. Because we are nurses, we are very caring people. We are trained to help folks. People like this know how to prey on others...they know all the right buttons to push. It is easy for us to get caught up in this type of scam. This is a lesson for all of us to learn. We cannot always trust what people post online. We should be alert and question the veracity of online assertions and balance empathy with circumspection. You must guard yourselves against getting sucked in. It is also important to not provide personal information to members you do not know.

If you suspect a member is posting deceitful information with the characteristics of this disorder, it is best to report your suspicions to the Administrators of this site or the site on which you are participating. They will take actions to investigate the matter. Remember......you are dealing with someone who is mentally ill, and their response to confrontation is unpredictable. Upon discovery of false posting, most Munchausen by internet scammers leave after possible denials. They search to find another online group on which they can prey.

Let me leave you with one last thought. We have always heard the phrase "If it seems to be too good to be true, it probably is." In this case... If it seems too bad to be true, it probably isn't.

To read more articles, go to my AN blog: Body, Mind, and Soul, Be the Nurse You Would Want as a Patient, From the Other Side of the Bed Rails - When the Nurse Becomes the Patient

References

Feldman, Marc D., MD. Bibby, and S. D. Crites, "'Virtual' factitious disorders and Munchausen by proxy," The Western Journal of Medicine  

Feldman, Marc D., MD, "Munchausen by Internet: Detecting Factitious Illness and Crisis on the Internet," Southern Medical Journal   

Feldman, Marc D., MD and Maheu, Marlene M., Ph.D., "Doctor Exposes Munchausen by Internet," SelfhelpMagazine

Feldman, M.D., (2004): Playing Sick?: Untangling the web of Munchausen syndrome, Munchausen by proxy, malingering, and factitious disorder. New York, Brunner-Routledge Hyman

Madrid, Cienna, "The Lying Disease: Why Would Someone Want to Fake a Serious Illness of the Internet?” www.thestranger.com

Russo, Francine, "Cybersickness - Munchausen by Internet Breeds a Generation of Fakers"

Smith, Morgan, "Munchausen by Internet: People Who Fake Illness and Death Online"

Swains, Harold, "Q&A: Munchausen by internet," Wired.co.uk

Szalavitz, Maia, "Munchausen by Internet: Faking Illnesses Online"

Munchausen by Internet: The Lying Disease that Preys on the Heart